Clinical Evaluation of a Wound Measurement and Documentation System

Marco Romanelli, MD, PhD; Valentina Dini, MD; Lee C. Rogers, DPM; Catherine E. Hammond, RN; Mark A. Nixon, MB, ChB

Disclosures

Wounds. 2008;20(9):258-264. 

In This Article

Results

The measured total areas and volumes for independent raters and for subsequent measures of 1 rater are displayed in Table 1 . No statistically significant differences were found between scans evaluated by the 2 investigators about wound area and volume. The relative error and the intra-class correlation coefficients are shown in Table 2 . The ICC values were excellent either for intra- or inter-rater reproducibility with a very low relative error value. The intra- and inter-rater measurement demonstrated its reliability as indicated by high ICC values (> 0.80). The mean±SD time for a full scan acquisition on the wound area and depth was 2.6±1.2 minutes.

Clinical Use in the Community Setting

The Wound Care Specialist service at Nurse Maude (Christchurch, New Zealand) serves a population of approximately 400,000. The service provides specialized wound care clinics where nurses assess, manage, and advise on complex chronic wounds. The team also works closely with community (home care) nurses and a multidisciplinary team to improve outcomes for chronic nonhealing wounds.

The device is used within the service to capture data and monitor progress within the 4 clinics, and can be employed in the patient's home.

The following case demonstrates how immediate, objective data can benefit the patient and improve outcomes.

Ms. K, age 33, was referred for specialist wound assessment of a Grade IV sacral pressure ulcer. She sustained the wound during a holiday overseas 9 months earlier and has since had a District Nurse (Home Care Nurse) visiting to re-dress the wound using vacuum- assisted therapy.

Ms. K has tetraplegia caused through a motor vehicle accident 5 years previously. She lives in her own home with 24-hour care support. Despite her bed rest, an alternating airwave mattress, and frequent turns, the wound was failing to progress at the expected rate causing Ms. K to become frustrated and angry.

On assessment the main factors affecting healing were identified as her severe frustration, inadequate pressure relief and inadequate intake of protein. The wound appeared dull and odorous suggesting heavy bacterial colonization, and was measured with the mobile device (Figure 5). Ms. K explained she was unable to tolerate bed rest and felt it had a minimal effect toward her healing.

Figure 5.

Images of Ms. K's wound: scaled area image (left) and depth measurement (right).

The heavily colonized wound was managed with a topical antimicrobial dressing, in the form of a silver contact wound layer, applied beneath the negative pressure dressing. It was agreed fortnightly wound measurements would be recorded. The management plan would be reviewed if progress was not maintained.

Four weeks later the wound had shown significant improvement. The mobile device provided objective data for both patient and nurse demonstrating a reduction in depth and the objective proof Ms. K needed to support her continuation with the treatment plan.

The report showing surface area, depth, and the graphed progress enabled both the nurse and Ms. K to pinpoint changes in her care. In one instance, over the course of a week Ms. K significantly increased the time she spent sitting at the computer, corresponding with an increased depth of the wound. This objective data resulted in concordance with the plan of care.

Since using the mobile device, Ms. K states that she feels more involved and has control of her care enabling her to work in partnership with the nursing team. Using the photographs and progress graphs she can make informed decisions in relation to her activities of daily living.

Clinical Use in Diabetic Foot Clinic

The diabetic foot clinic or wound healing center is a specialized center where all aspects of the ulcer can be managed with advanced techniques and in a multidisciplinary setting. There are many products available to treat wounds at varying stages and some are quite costly. To adequately determine if a product or device is improving, precise wound measurements must be documented at each visit. Many centers use "standard of care" treatment protocols for the first 4 weeks to determine the need for advanced products. If the wound fails to heal by 50% area in 4 weeks, it has a 91% negative predictive value of healing at 12 weeks.[7] In these particular cases, more advanced and expensive products are necessary. This emphasizes the importance of accurate wound assessments. Manual length x width measurements of wounds are not accurate. Length x width assessments are mathematically accurate for measuring the area of a square, but not a circular or otherwise irregularly shaped wound.

The mobile device product suite offers the diabetic foot clinic the ability to accurately measure wounds, chart progress on a graph, manage/store data, and print reports. These enhancements can improve appropriate utilization of advanced products and outcomes.

Patient A has an uninfected, nonischemic plantar diabetic foot ulcer that received regular debridement and appropriate offloading. In 4 weeks this ulcer decreased in size from 4.8 cm2 to 1.1 cm2 (78%). In this case, the wound was predicted to heal within 12 weeks, at which point the current treatment would be continued (Figure 6).

Figure 6.

A mobile device graph showing improvement by 78% in the wound area over 4 weeks.

Patient B has diabetes and a venous leg ulcer. The ulceration initially decreased in size over 2 weeks, but then stagnated for the following 2 weeks. This would require a change of treatment to attain wound closure (Figure 7).

Figure 7.

A mobile device graph showing a decrease in area over the first 2 weeks of wound treatment, then no further improvement.

The mobile device allows wound-healing professionals to noninvasively track wounds and direct advanced treatments to wounds that would not heal with standard care alone, thus conserving costs to the healthcare system and diabetic foot clinic.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....